Family Doctors Take It On the Chin

“Reform” brings more pain than gain, physicians say.

Kathy Finn

It is no exaggeration to say that the massive, exceedingly complex bureaucracy that is the American health care industry profoundly affects every citizen of the United States. Most people experience a great many medical interventions during their lifetimes, and very few could afford the care without assistance.

As the people and government of the United States struggle to pay for so much care, it’s important to remember that it isn’t just patients who are placed at risk by the soaring costs of medicine. Many doctors are struggling, too.

Though the United States spends more than $8,000 per citizen on health care annually – more than twice the amount of any other industrialized nation – a growing number of U.S. physicians find it tough to make ends meet. Among those most drastically affected are those who are in critically short supply: primary care physicians.

The nonprofit organization Physicians Foundation has repeatedly warned that the growing regulatory and administrative burdens that government lays on doctors are taking a big toll. Full-time independent practitioners are gradually becoming an extinct species, the foundation says. And when it comes to those who once were known simply as “family doctors,” an “acute shortage” lies ahead.

That is hardly news to Floyd Buras, a Metairie pediatrician who, for more than 30 years, has operated a private medical practice in the local area.

Buras loves his work and the fact that he has been able to practice in his hometown during his entire career. Having grown up in the Gentilly neighborhood of New Orleans, he practiced there from the time he finished medical school at Louisiana State University until 2005, when the Hurricane Katrina flood wrecked his office and the neighborhood.

He and his partner, Richard Leboeuf, moved their practice to an office in Metairie, where Buras says they “pretty much had to start over from scratch” because their patients had scattered far and wide to new homes.

Still, Buras says, everything was going pretty well until recently. Now, he says, “We have creditors beating on our doors, and we’re wondering if we’re going to be able to stay afloat.”

Buras, a former president of the Louisiana State Medical Society and a Louisiana delegate to the American Medical Association, says the malaise that’s eating away at his practice stems from government regulations and bureaucracy.

As physicians who primarily treat the earaches, colds and broken limbs of children who are growing up in low-income families, he and his associates derive most of their income from Medicaid.

While Medicaid, a federal health care insurance program administered by individual states to assist people of limited resources is, itself, a massive bureaucracy, Buras says that over time he came to understand the ins and outs of the reimbursement system. As a result, his practice fared well.

But last year, the state placed the administration of benefits for some 1.2 million Medicaid recipients in the hands of five private companies. The startup of that privatized system early this year, Buras says, may have marked the beginning of the end for his practice.

“It’s a bureaucratic morass,” he says. “They could not have done a worse job in starting it up.”

As of late June, Buras’ practice had gone more than four months without receiving a Medicaid reimbursement through the new system. “I don’t have enough cash flow to pay my bills,” he says.
If the new Medicaid difficulties were the only problem facing Buras and other doctors, the picture might not be so bleak. But there’s more.
Seemingly continual administrative changes in the federal government’s health claims filing practices and regulatory compliance issues are adding new costs and frustration.

“There are 25 to 30 separate federal agencies writing rules and regulations, and each one has its own timeline for implementation,” Buras says.

“What we’re realizing is that all of those timelines are beginning to converge, and the issue for a small or private practice is, you’ve got all these expensive government-mandated changes happening at the same time.”

Doctors throughout the country, particularly those who remain in small or private practices, have their own versions of the story Buras relates.

Everywhere one turns within the U.S. health care system, it’s clear that the costs of complying with regulations and government mandates are beginning to outweigh, or already have exceeded, the resources devoted to direct patient care.

Meanwhile, the inexorable march toward the vague goal of health care “reform” continues, with the U.S. Supreme Court recently upholding the validity of President Obama’s plan to require all Americans to have health insurance coverage.

It will be a while before the impact of that hotly debated plan becomes clear, but in the meantime, there are few signs that the pressures on doctors will ease.

“The practice of medicine has become a relationship with government, which sets the rules,” Buras says. “My ability to do what I think is best for the patient is restricted by what the government says is best for the patient.”

This constant bumping of heads with government isn’t merely frustrating for doctors; it’s career-altering.

In a survey of 500 doctors under the age of 40 conducted by the Physicians Foundation and released in April, nearly 60 percent said they are pessimistic about the future of American health care.

Research by the foundation predicts that some physicians will respond to the administrative onslaught “by opting out of private practice or by abandoning medicine altogether.”